Posted!

Join the Conversation

Comments

Welcome to our new and improved comments, which are for subscribers only.
This is a test to see whether we can improve the experience for you.
You do not need a Facebook profile to participate.

You will need to register before adding a comment.
Typed comments will be lost if you are not logged in.

Please be polite.
It's OK to disagree with someone's ideas, but personal attacks, insults, threats, hate speech, advocating violence and other violations can result in a ban.
If you see comments in violation of our community guidelines, please report them.

On Thursday evening, a Des Moines Register editorial writer interviewed Dr. Tom Benzoni, an emergency room physician at Iowa Methodist Medical Center in Des Moines. We first interviewed him in March, but wanted to check back with him as the novel coronavirus pandemic unfolds in Iowa. He is not speaking on behalf of the hospital, but shared his personal thoughts and observations. Here are edited excerpts from the interview:

Can you talk about working in the ER right now?

Like everyone entering the hospital, I stop at the triage table for a no-contact temperature screening and to answer three questions: Any myalgia (muscle pain)? Any fevers? Any cough? No, no, no.

I’m an old guy and so I don’t tend to dress in scrubs. I traditionally wear a shirt and tie. I’ve gotten rid of the tie lately.

When I get to a patient’s room, I scan the chart. I had to sew up a guy’s finger today. I’m not going to put on PPE for a laceration. Now if I’ve got someone with COVID-19 symptoms, that’s different. I carry my own goggles and I have my own face shield. When I first open the door, I don’t have my mask on. I say the person’s name and my name and then I put the mask on and stay by the foot of the bed.

When I have to get up close to the patient, I hold my breath.

What has changed with patients the past few weeks?

It’s odd. We are seeing patients who are sicker than usual, but not as many patients. Where are the heart attacks and strokes?

People may be afraid to come to the hospital because they’re worried we’re busy, but some are also afraid to be there. We had a guy come in with classic stroke symptoms, but instead of staying to get checked out, he left. Because he was afraid of contracting COVID-19.

Patients came in last night only because they wanted to be tested after hearing some new information about symptoms. But getting test results takes a week right now.

What else?

Well, there are the people starving for human contact. This includes psych patients who can’t “see” somebody unless they come to the ER. They wait until doctors’ offices have put away telemedicine tools like Zoom and then come to the ER where they won’t get turned away.

While these patients tend to have baseline poor coping skills, what they’re doing is really adaptive, if you think about it.

What do you do with those patients?

I say to myself, this is a person who wants human contact, and that’s really normal. There’s a natural tendency among people to want to be among people. That’s what cities are about. That’s a natural function. We congregate. When you tell people they can’t congregate, they’ll find a way to congregate.

Do you feel safe at work?

“You” singular or plural as in the staff?

Singular. You.

I trained in Detroit. I’ve had guns and knives in the ER. I’m sure in recent months I’ve been exposed 15 or 20 times to this coronavirus.

And I’m concerned about poor leadership. Though Des Moines has been pretty good, the lack of honesty across the country is what really irritates me. The first thing you do as a leader is tell the truth. Say "here is our personal protection stock, here’s our supply chain, here’s our expected delivery date.” At this burn rate, we will run out of PPE and our supply chain won’t get it to us.

Do you think elective surgeries should resume?

First we need widespread testing and markers. And I mean random testing of people on the street. This is the only way we can know if there’s a high concentration of the virus in a city. If so, that city shelters in place. If not, maybe we open up some elective surgeries in a tiered way.

First would be urgent electives, like somebody who has gallbladder symptoms and is eventually going to have to have a gallbladder out. Then non-urgent electives like hip replacements. Then things like cosmetic surgery.

Also, fewer elective surgeries have meant we aren’t seeing ER patients with surgical complications. Some may not have needed the surgery anyway. Look at the natural history of back pain. For many patients it goes away on its own.

But remember, elective surgery is where hospitals make their money. We need revenue.

Can you talk about what doctors are learning as the pandemic unfolds?

We’re learning a fantastic amount quickly about a new disease, which is a rare opportunity. For example, not everybody with low oxygen needs a ventilator. We have found that by turning them over, putting them in a prone position, you can help get air to the lungs. Doctors on the East Coast were saying, "Wait a minute. These patients with such low levels of oxygen should not be able to talk to me.”

This knowledge comes from treating patients. That is the essence of emergency medicine — to step back from a crisis and think extremely simply.

We are also learning a lot of the touted medications don’t make any difference. So far pretty much nothing works but good basic care. I see some hope with convalescent serum where you use plasma from recovered people to treat very sick people. And I'm learning to talk to patients about the coronavirus, to get them to chill out.

Are you spending more time than usual calming people down?

Yes. And you have to understand running a test on somebody does not calm people down. If I run a pregnancy test, then you start worrying about being pregnant. Patients worry about what they think I’m worrying about.

Have you signed up with the new Test Iowa program?

I registered right away. (On Monday he said he had scheduled a time). I want to reiterate the testing we need is stochastic, random testing over time to understand the location of the virus.

Is there anything else you want Iowans to know?

For God’s sake, if you need to come to the ER, come to the ER. If you’re really sick, come in.

When we talked a few weeks ago, you hadn’t gotten takeout food from a restaurant. Has that changed?

Businesses are being so damn kind. If you show your hospital badge at some restaurants, they give you free food. People are doing what they can by giving what they have. When I told some nurses about this, one of them looked at me and said she would feel awfully guilty about taking free food when others are hungry.